“How I Treat Axillary Hyperhidrosis” Using RF Microneedling (Genius/Infini)

1. Consent – include pain, tenderness, infection, inadequate improvement, need for further treatments, PIH, scarring, compensatory sweating elsewhere, hair loss
2. Starch-iodine sweat test and mark treatment area. Hair must be shaven.
3. Apply 23%/7% lidocaine/tetracaine topical from Central Ave Pharmacy, Lipothene for at least 1 hour – 1.5 hours. Use 30% lidocaine ointment for darker skin types.
4. Subsequent analgesia might be needed with either injections using mesoram device and lidocaine with epi mixture (5cc lido w epi/5cc saline/1cc bicarb) or just inject
5. Pronox  (Nitrous oxide mixture “Laughing Gas”) can be used as well.
6. Clean off ointment with alcohol and clean skin with Hibiclens
7. Use Zimmer air chiller and/or ice, ice roller, or Frozen C
8. Perform 1-2 passes with each depth of Genius with breaks after each pass to chill and go to opposite side.
9. 3 depths – 3.5, 3.0, 2.5mm – go deep to superficial with subsequent passes
10. Energy/pin 40-60mj. Lower energies in darker skin types, poor pain tolerance
11. (For Infini – Treatment level 3-5, 300-400msec if tolerated)
12. Use sterile technique throughout – sterile gauze, sterile gloves, sterile saline
13. Keep eye on skin reaction – avoid excessive heat build up, redness. Abort procedure if skin not tolerating energies.
14. Infrared camera, if available, to monitor skin surface temperature – stay below 42C
15. Clean skin with sterile gauze and saline.
16. Apply Clindamycin gel.
17. In darker skin types, consider 4% hydroquinone 1 week prior and for 4-6 weeks after.
18. Expect decreased sweat in less than one week.
19. Repeat treatment in 6 weeks or longer.
20. 2-3 treatments needed to have “controllable sweating”.

https://stevenfweinermd.wordpress.com/2015/10/09/hyperhidrosis-of-face-body-and-axilla-can-be-treated-permanently-using-the-infini/